Severe Hyperthyroidism Complicated by Agranulocytosis Treated with Therapeutic Plasma Exchange: Case Report and Review of the Literature

Table 2

Literature review.

Authors	Cases	Indication	Indication for plasmapheresis	Outcome
Kaderli et al.	3	Amiodarone induced thyrotoxicosis	Amiodarone induced thyrotoxicosis	Underwent thyroidectomy
Min et al.	1	Graves’ disease	Elevated liver function tests	Biochemical improvement with about 40% decrease in total T3
Aydemir et al.	1	Graves’ disease	Jaundice	Biochemical improvement with greater than 60% decrease in FT4 and FT3
Bilir et al.	1	Graves’ disease	Drug induced angioneurotic edema	Underwent thyroidectomy
Carhill et al.	2	Graves’ disease	(1) Increase in transaminases; (2) Unresponsive to standard treatment	Clinical and biochemical improvement
Vyas et al.	1	Exogenous intoxication	Exogenous etiology	Clinical and biochemical improvement
Lew et al.	1	Graves’ disease	Agranulocytosis and hemophagocytosis	Clinical and biochemical improvement with greater than 80% decrease in FT4 and FT3
Enghofer et al.	1	Graves’ disease	Fulminant hepatitis	Underwent thyroidectomy
Koball et al.	1	Unknown	Preparation for urgent thyroidectomy	Clinical and biochemical improvement
Ezer et al.	11	(7) Graves’ disease; (3) Toxic multinodular goiter; (1) Iodine induced thyrotoxicosis	(7) Unresponsive to standard treatment; (3) Agranulocytosis; (1) Emergent preparation for thyroidectomy	Clinical improvement noted
Adali et al.	1	Gestational hyperthyroidism sec to molar pregnancy	Emergent preparation for thyroidectomy	Biochemical improvement with >80% decrease in FT3 and >75% decrease in FT4
Pasimeni et al.	1	Contrast induced hyperthyroidism	Unresponsive to methimazole	Clinical and biochemical improvement
Azezli et al.	1	Gestational hyperthyroidism sec to molar pregnancy	Preparation for emergent thyroidectomy	Clinical and biochemical improvement with 75.1% decrease in free t3 and 63.1% decrease in free t4
Erbil et al.	1	Gestational hyperthyroidism sec to molar pregnancy	Unresponsive to propylthiouracil	Biochemical improvement
Guvenc et al.	1	Toxic multinodular goiter	Agranulocytosis	Clinical and biochemical improvement
Ozbey et al.	4	Graves’ disease	(1) Agranulocytosis; (1) PTU induced vasculitis; (1) Drug induced urticarial; (1) Hepatotoxicity	Decrease in TT3 by about 40–78% and FT4 by >69%
Diamond et al.	3	Amiodarone induced thyrotoxicosis	Unresponsive to standard treatment	Clinical improvement in 2 patients; Mild decrease in the FT4
Petry et al.	1	Graves’ disease	Status after sleeve pneumonectomy	Clinical and biochemical improvement
Ozdemir et al.	1	Hyperthyroidism	Unresponsive to standard treatment	Clinical and biochemical improvement with 60% decrease in FT4 and 75% decrease in FT3
Segers et al.	5	Thyrotoxicosis	Thyrotoxicosis	Clinical improvement. Decrease in FT3 of 63.5% and FT4 by 57.8%
Ligtenberg et al.		Preparation for surgery	Preparation for surgery	Decrease in FT3 of 7% and 18%; Decrease in FT4 of 0% and 33%
Samaras et al.	1	Amiodarone induced thyrotoxicosis	Unresponsive to standard treatment	Failure of treatment resulting in death of the patient; Decrease in TT3 and TT4 noted after TPE with rebound increase in levels later
Aghini-Lombardi et al.	2	Amiodarone induced thyrotoxicosis	Adjunct to methimazole	Decrease in FT4 and FT3; Normalization of TT4 and TT3
De Rosa et al.	1	Hyperthyroidism	Agranulocytosis	Biochemical improvement with 51% decrease in FT3, 47% decrease in FT4, 60% decrease in TT3, and 53% decrease in TT4
Binimelis et al.	6	Levothyroxine intoxication	Cardiac and neurological symptoms	Clinical and biochemical improvement in 15 days
Jha et al.	1	Medicinal thyroid overdose	Medicinal thyroid overdose	Clinical and biochemical improvement with 43% decrease in TT4 and 68% decrease in TT3
Ashkar et al.	3	Hyperthyroidism	Severe hyperthyroidism	Clinical improvement in 2-3 days

Ft4: free thyroxine, Ft3: free triiodothyronine, TT4: total thyroxine, TT3: total triiodothyronine, and TPE: therapeutic plasma exchange.